Urinary tract infections in children.
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Bacteriuria↗
Biomedical subjects
M Sieniawska
Publications and source records attributed to M Sieniawska.
Recombinant human erythropoietin dosage in children undergoing hemodialysis and continuous ambulatory peritoneal dialysis.
The efficacy of erythropoietin (EPO) in 11 children on hemodialysis (HD) and 8 on continuous ambulatory peritoneal dialysis (CAPD) (mean age 11.8 years) was compared. The initial EPO dose was 50 U/kg s.c. once a week; the time of observation was 24 weeks. In the CAPD group, the mean hemoglobin (Hb) level increased from 7.7 +/- 0.2 to 11.2 +/- 0.6 g/dl (P < 0.001) and hematocrit (Hct) from 22.3 +/- 1.0 to 32.6 +/- 1.4% (P < 0.001), while in the HD group the mean Hb rose from 7.7 +/- 0.6 to 9.3 +/- 0.8 g/dl (P < 0.001) and mean Hct from 22.7 +/- 2.3 to 27.6 +/- 2.8% (P < 0.001) after 12 weeks of observation. An increase in Hb to over 10 g/dl was obtained in 87.5% of children on CAPD but in only 10% on HD after 8 weeks of EPO treatment. After 12 weeks of treatment, all children on CAPD had the target Hb level of more than 10 g/dl, while 7 children on HD required increased doses of EPO (100 U/kg per week). We conclude that the EPO dose of 50 u/kg given s.c. once a week is effective for children with anemia on CAPD but is insufficient for children on HD.
Adolescent↗
Bilateral primary renal Burkitt lymphoma in a child presenting with acute renal failure.
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Acute Kidney Injury↗
Changes in the phagocytic cells in children treated with continuous ambulatory peritoneal dialysis.
Children on continuous ambulatory peritoneal dialysis (CAPD) in endstage renal failure are highly exposed to peritonitis. Peritoneal macrophages (PM) and blood neutrophils (PMNC) are the first line of defense against invading microbes. This study was undertaken for assessing surface receptors expression on PM and PMNC and to check their ability to phagocytosis and killing of bacteria. We have found that in spite of the decreased number of PM in dialysate fluid their viability and activity significantly increased during CAPD. Moreover, higher number of PM expressed CD16 and CD35 antigens (FcRIII and C3bR, respectively) in comparison with the results observed at CAPD onset. The number of PMNC expressed of these two antigens in uremic children blood were significantly lower in comparison with healthy control. The number of CD16 positive cells increased under influence of CAPD only temporarily. CAPD caused improvement of phagocytosis and intracellular killing of bacteria by PM but not by PMNC. There is discussed here influence of uremia and CAPD on surface antigens, function of phagocytes as well as renewal of PM during CAPD.
Adolescent↗
The influence of dialysate calcium concentration on the PTH level in children undergoing CAPD.
In 12 children aged four-and-a-half to 18 years (mean 11 +/- 4.2) undergoing continuous ambulatory peritoneal dialysis (CAPD), serum intact parathyroid hormone (iPTH), ionized calcium (iCa) levels, and calcium mass transfer (CaMT) were measured on three consecutive days: day 1, after a four-hour interval between dialyses; on day 2, after four hours dwell time with peritoneal dialysis (PD) Ca 3.5 mEq/L; and on day 3, after four hours dwell time with PD Ca 2.5 mEq/L. A significantly more negative CaMT was found when PD Ca 2.5 mEq/L was used, as compared with values obtained using PD Ca 3.5 mEq/L. Significantly lower parathyroid hormone (PTH) values were found after the interval between exchanges. We conclude that in order to properly evaluate parathyroid gland function and to decide whether or not to give vitamin D metabolites, a protocol for determining PTH should be standardized.
Adolescent↗
[Clinical course and treatment results of IgA nephropathy in children].
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria became longer. In 3 of 8 children with nephrotic syndrome, chronic renal failure as well as end-stage renal disease were observed. In 2 of them hypertension was present during the entire observation period and it was difficult to achieve control using hypotensive drugs. In the remaining 2 children, regression of nephrotic syndrome was found, but slight proteinuria and hypertension are observed.
Acute Kidney Injury↗
[Immunoglobulin skin and renal deposits in patients with IgA nephropathy and Schonlein-Henoch purpura].
Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children with Schönlein-Henoch purpura (SHP). Renal biopsy was done in all patients with IgAN and in 51 of 62 with SHP. There was no correlation between presentation of immunological deposits in skin and renal biopsy. Deposits of IgA with or without other deposits or other deposits without IgA were observed in different pathomorphological states. Correlation between IgA serum concentration and presentation of deposits in skin was not observed. Attention was drawn to the high proportion of negative results in skin biopsy.
Adolescent↗
The influence of growth hormone treatment on bone metabolism in dialysis patients.
Bone formation markers, PTH intact, and bone mineral density were evaluated in 12 children with end stage renal disease during recombinant human growth hormone (rhGH) treatment. Bone biopsies before rhGH therapy revealed: osteitis fibrosa in one patient, mild lesions in eight, adynamic bone disease in one, and a normal histology in two. PTH intact increased after six months of rhGH in seven children, and was significantly higher in them than in the control group. A positive correlation between PICP concentration after one month and growth velocity within 12 months of rhGH was found. Higher doses of vitamin D are needed in growing children treated with rhGH.
Adolescent↗
[The diagnostic value of cytology in children on continuous ambulatory peritoneal dialysis (CAPD)].
Peritonitis is a common clinical problem that occurs in patients undergoing CAPD. Early diagnosis of this complication is difficult in some cases and elevated peritoneal cell count may be a misleading factor in diagnosis. The aim of the study was to determine the cell count in consecutive dialysate exchanges after starting CAPD. Elevated peritoneal cell count was found in 17 of 21 (80%) analyzed periods at the beginning of CAPD. Peritonitis was diagnosed in 5 of these patients and confirmed by culture in 4 and clinical observation in 1. In the remaining 12 cases (70%) the elevated cell count normalized during consecutive exchanges of dialysate. The coexistence of such nonspecific symptoms as fever, abdominal pain of varying intensity, cloudy fluid with or without the presence of fibrin can be the cause of diagnostic mistake and institution of unnecessary antibiotic treatment. In doubtful case, the reduction of the dwell time to 2 hours and observation of the cell count in consecutive exchanges is very helpful, especially if rapid culture diagnosis is not available.
Adolescent↗
[The influence of hepatitis B vaccine dose on direct results of hepatitis B vaccination in children with nephrotic syndrome].
In the first phase of the study on the efficacy of vaccination against hepatitis B with a double dose of the vaccine in children with steroid-sensitive nephrotic syndrome (NS), the best results were obtained in the group of patients in remission of NS. The aim of the present study was to compare the efficacy of standard and double doses of the vaccine in patients in remission. After excluding HBV infection, recombinant hepatitis B vaccine was administered i.m. according to the 0, 1, 2 month protocol in a standard dose in group I and a double dose in group II. In both groups the seroprotection rate was similar (I group-96%, II group-93%), however the anti-HBs antibody level was significantly higher in group II during a 3 month observation period.
Child↗
[Correlation between osteocalcin and bone histomorphometry in children with chronic renal failure].
The study was performed in 17 children with chronic renal failure, 7 were on hemodialysis, 6 on continuous ambulatory peritoneal dialysis, 4 were treated conservatively. In all, serum levels of alkaline phosphatase, PTH intact and osteocalcin were measured and bone biopsy was performed. We analyzed correlations between biochemical markers of bone metabolism and histomorphometric parameters. The lowest mean serum osteocalcin levels were found in children with adynamic bone disease, the highest with osteitis fibrosa. The serum osteocalcin level was significantly correlated with the dynamic parameter of bone formation rate (BFR), which suggests that this biochemical marker can be of use in discriminating between renal osteopathy with low and high bone turnover. Lack of correlation between serum osteocalcin level and mineralizing surface confirms it significance as a good marker of osteoblastic activity in bone formation but not in bone mineralization.
Alkaline Phosphatase↗
[The effect of decreasing serum calcium in serum during hemodialysis on PTH levels in children with end stage renal disease].
The aim of our study was to evaluate serum Ca and PTH intact levels in children during one hemodialysis session using a low calcium level dialysate (1.25 mEq/l). The study was performed in 6 children with end-stage renal disease. We analysed the parameters of calcium-phosphorus metabolism in children 18 months before the test. In 5 of children the increase of PTH level during hemodialysis was lower than in healthy people. In 3 patients with hyperparathyroidism the basal PTH (PTHb) level before the test was high and increased by 45%, 67% and 118% during hypocalcemic stimulation. In 2 patients suppression of parathyroid function was diagnosed due to low serum PTHb level and small increase during hypocalcemic stimulation. Despite low basal PTH level, one of the patients respond to hypocalcemic stimulation like healthy subjects. Dynamic monitoring of the PTH level during hypocalcemic stimulation is a very useful method of estimation parathyroid gland function and adjusting doses of vitamin D metabolites.
Adolescent↗
[Dosage of erythropoietin in children treated with hemodialysis and continuous ambulatory peritoneal dialysis].
The authors compared the efficacy of erythropoietin (EPO) in a standard dose of 50 U/kg/week used in children undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). It was concluded that this dose is suitable for children on CAPD. Hemoglobin increased to > 10 g% and Ht > 30% after 8 weeks in 83% of patients and in all of the treated patients after 12 weeks.
Adolescent↗
[Long-term efficacy of hepatitis B vaccine in children with chronic renal failure].
The aim of the study was to determine the duration of post vaccination immunity and antibody persistence in children in different stages of chronic renal failure. The study was performed in 25 children and time of observation was 12-36 months. After completing vaccination seroprotection rate was 92% in non-dialysed children and 77% in dialysed. After 36 months of observation seroprotection was found in 90% of patients, none of them was infected by HBV. We conclude that in case of decrease in antibody titer below 100 mIU/ml the booster dose of vaccine is indicated.
Adolescent↗
Swan neck presternal catheter for continuous ambulatory peritoneal dialysis in children.
Since 15 December 1991 four swan neck presternal catheters (SNPC) have been implanted in four children aged 2-11 years. The observation period ranged from 4 to 10 months. The aim of this study was to evaluate the usefulness of a new peritoneal dialysis catheter implantation method in paediatric patients. The indications for insertion of the SNPC were: young age, use of nappies, obesity and recurrent exit site infection (ESI). The surgical technique of the SNPC implantation was similar to that used for adults. The chest location of the catheter exist site is advantageous for the following reasons: (1) easier care of a small child because of greater distance from nappies, (2) better healing and decreased risk of ESI in the area with less fat thickness and (3) less trauma. A larger number of children with a longer follow-up is necessary for better evaluation of the SNPC, as well as for estimation of frequency of ESI and peritonitis.
Catheters, Indwelling↗
Preliminary results with the Swan neck presternal catheter for CAPD in children.
Exit-site infection (ESI) in children on continuous ambulatory peritoneal dialysis (CAPD) is a complication observed mainly in obese patients and patients wearing diapers. From 15 December 1991 to 28 February 1993, five Swan neck presternal catheters (SNPCs) were implanted in 5 children aged 2-11 years. The criteria for insertion of a SNPC were the following: young age in 1 child, obesity in 2, recurrent ESI in 2, and the use of diapers in 2. In some patients there was more than one criterion. The observation period ranged from 1-10 months, and the time on CAPD with the SNPC was 1-9 months. During this period, we did not observe any catheter-related problems. The potential advantages of the chest location of the catheter exit site are the following: 1. easy exit-site care; 2. decreased risk of ESI in small children because of greater distance from wet diapers; 3. avoidance of trauma with crawling/creeping; and 4. better healing and decreased risk of ESI in the area with less fat thickness.
Catheters, Indwelling↗
The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome.
The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was evaluated in 17 children. Cow's milk was excluded from the diet for at least 14 days without changing previously ineffective prednisone dosage. Six patients with minimal change or mesangial proliferation went into remission 3 to 8 days after elimination of cow's milk. After a period of 2-3 weeks of remission, cow's milk challenge was positive in three patients. After one year on a cow's milk-free diet, two of six patients became milk tolerant and are in remission of NS, one of six became steroid-dependent, two of six are still unable to tolerate cow's milk and are in remission on a cow's milk-free diet and one of six children was lost from observation. The role of cellular mechanisms in steroid-resistant nephrotic syndrome is suggested.
Adolescent↗